Site Survey

Please complete the fields listed below.


Customer Name (required)

Address (Please include floor/room #)

Your Email (required)

Purchasing Contact

Purchasing Contact Phone (Please include ext.)

IT Contact Name

IT Contact Phone

Sales Rep (Please include name & ext.)

Delivery Date

Pick Up Date

Hours of Operation

Check all that apply Field DemoIn-house DemoTrialSaleOther

Demo Date & Time

Machine Requested (include model #)


Any outside steps? YesNo
If Yes, how many?

Any inside steps? YesNo
If Yes, how many?

Truck Dock? YesNo

Are all doors wide enough? YesNo

Are all elevators wide enough? YesNo

Are all hallways wide enough? YesNo

Is there enough space where the copier will be placed? YesNo

Is there dedicated power for the copier?YesNo

CSR training? YesNo

Please list any special applications or circumstances that may require additional consideration: